James L. Wilson

Premature mortality in the United States: the roles of geographic area, socioeconomic status, household type, and availability of medical care.

OBJECTIVES This study examined premature mortality by county in the United States and assessed its association with metro/urban/rural geographic location, socioeconomic status, household type, and availability of medical care. METHODS Age-adjusted years of potential life lost before 75 years of age were calculated and mapped by county. Predictors of premature mortality were determined by multiple regression analysis. RESULTS Premature mortality was greatest in rural counties in the Southeast and Southwest. In a model predicting 55% of variation across counties, community structure factors explained more than availability of medical care. The proportions of female-headed households and Black populations were the strongest predictors, followed by variables measuring low education, American Indian population, and chronic unemployment. Greater availability of generalist physicians predicted fewer years of life lost in metropolitan counties but more in rural counties. CONCLUSIONS Community structure factors statistically explain much of the variation in premature mortality. The degree to which premature mortality is predicted by percentage of female-headed households is important for policy-making and delivery of medical care. The relationships described argue strongly for broadening the biomedical model.

Childhood Acute Respiratory Infections and Household Environment in an Eastern Indonesian Urban Setting

This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children’s respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children’s bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother’s education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children.

Life in a landfill slum, children's health, and the Millennium Development Goals.

People living in slums can be considered left behind with regard to national successes in achieving Millennium Development Goals (MDGs). The objective of this study was to evaluate the living and working conditions of waste pickers and their children in a landfill slum located in the largest city in eastern Indonesia. A total of 113 people from the landfill slum and 1184 people from the general population participated in face-to-face interviews. Municipal solid waste (MSW) was analyzed for metals, metalloids and fecal indicator bacteria. Ambient air quality including particulate matter was measured in the landfill. Households in the landfill slum were 5.73 (p=0.04) times more likely to be below the international poverty line (MDG 1: Poverty) and 15.6 times (p<0.01) more likely to have no one in the household possessing a primary education (MDG 2: Universal Education), and 107 times (p<0.01) more likely not to have improved sanitation facilities (MDG 7: Environmental Sustainability) when compared to the general population. Diarrhea is one of the leading causes of death in children under five in Indonesia. Young children living in the landfill slum were 2.87 times (p=0.02) more likely to develop diarrhea than their general population counterparts. Other survey results and environmental measurements suggest that landfill slum children have additional adverse health effects (e.g. infections and poisoning). Poverty underlies several MDG issues that directly or indirectly affect child health. Therefore, eradicating extreme poverty will continue to be the most critical challenge for the MDGs beyond 2015.

Challenges in evaluating PM concentration levels, commuting exposure, and mask efficacy in reducing PM exposure in growing, urban communities in a developing country.

Particulate matter (PM) contributes to an increased risk of respiratory and cardiovascular illnesses, cancer, and preterm birth complications. This project assessed PM exposure in Eastern Indonesias largest city, where air quality has not been comprehensively monitored. We examined the efficacy of wearing masks as an individual intervention effort to reduce in-transit PM exposures. Handheld particulate counters were used to investigate ambient air quality for spatial analysis, as well as the differences in exposure to PM2.5 and PM10 (μg/m(3)) by different transportation methods [e.g. motorcycle (n=97), pete-pete (n=53), and car (n=55); note: n=1 means 1m(3) of air sample]. Mask efficacy to reduce PM exposure was evaluated [e.g. surgical masks (n=39), bandanas (n=52), and motorcycle masks (n=39)]. A Monte Carlo simulation was used to provide a range of uncertainty in exposure assessment. Overall PM10 levels (91±124 μg/m(3)) were elevated compared to the World Health Organization (WHO)s 24-hour air quality guideline (50 μg/m(3)). While average PM2.5 levels (9±14 μg/m(3)) were below the WHOs guideline (25 μg/m(3)), measurements up to 139 μg/m(3) were observed. Compared to cars, average motorcycle and pete-pete PM exposures were four and three times higher for PM2.5, and 13 and 10 times higher for PM10, respectively. Only surgical masks were consistent in lowering PM2.5 and PM10 (p<0.01). Young children (≤5) were the most vulnerable age group, and could not reach the safe dosage even when wearing surgical masks. Individual interventions can effectively reduce individual PM exposures; however, policy interventions will be needed to improve the overall air quality and create safer transportation.

Understanding modifiable risk factors associated with childhood diarrhea in an eastern Indonesian urban setting

This study evaluated multiple factors that may contribute to an increased risk of childhood diarrhea in eastern Indonesia. Mothers with at least one child under the age of 5 years (n = 303) were interviewed face-to-face in two sub-districts of a large city in eastern Indonesia. Results showed that children were 4.72 times more likely to develop diarrhea if mothers washed their hands without soap after defecation (95% confidence interval (CI) 1.22–18.3; p = 0.03), 3.83 times more likely if households had no access to improved sources of drinking water (95% CI 1.12–13.1; p = 0.03), and 3.21 times more likely if households had income levels below

Disease, Death, and the Body Politic: An Areal Interpolation Example for Political Epidemiology

152/month (95% CI 1.40–7.35; p < 0.01). Although lower household income did not influence accessibility to improved drinking water sources, lower income households more likely lacked a refrigerator (odds ratio (OR) = 8.96; 95% CI 4.87–16.5; p < 0.01) and were also associated with mothers who had no primary education (OR = 5.44; 95% CI 1.71–17.3; p < 0.01). Mothers without primary education tended to think childhood diarrhea was not life threatening (OR = 10.8; 95% CI 3.45–33.6; p < 0.01), and mothers with such a perception were more likely wash their hands without soap after defecation (OR = 9.31; 95% CI 2.80–31.0; p < 0.01). In order to protect low-income children from diarrhea, it will be necessary to apply multiple health promotion efforts at both individual and community levels. Promoting mothers’ education is a key intervention for improving childhood health.

Topography, Culture Areas, and Integration of Retired Migrants in a Coastal North Carolina County

More than a trillion dollars of public money is spent annually on health care in the United States. In order to inform policymakers, health advocacy groups, tax-paying constituents, and beneficiaries, it would be useful to present and analyze health outcome and health-related data at the U.S. congressional district level. Presently, health event data are not reported at this political unit; however, recent interest and advances in areal interpolation techniques are beginning to transcend the inherent limitations imposed by legacy data collection and analyses systems. In this paper, the authors use the dasymetric approach to illustrate how this areal interpolation technique can be used to transfer county-level mortality rate data from several causes of death to the U.S. congressional district level. The study’s primary goal is to promote areal interpolation techniques in the absence of a systematic and comprehensive national program for geocoding health events.

Commute times, food retail gaps, and body mass index in North Carolina Counties

The later life migration literature includes analyses of migration streams, examination of later life migration precursors, the economic impact of migration, and meta-analyses advocating methodological refinement. Missing are studies of later life migrants post relocation, including their social integration in receiving communities. The small area analysis presented here evolved in consultation with a local Planning Committee including older adults and service providers that guided development of an aging services plan for Dare County on the North Carolina Outer Banks. Multiple methods were applied, including secondary historical and contextual data, in-depth interviews, and a brief survey of older adults using services. Findings suggest difference among communities in the integration of later life migrants with older natives that provides context for service needs and delivery. Community difference stems from topographical land form characteristics, socioeconomic and cultural difference between later life migrants and older natives, and the course of residential development across communities.